Derm Flashcards
Treatment of gas impetigo
Usually presents as honey crusted erosions on the face, coalescing
Treated with topical mupirocin ointment applied TID
How to treat a furuncle and if seen in large numbers, what could it be?
An acute, deep seated, red, hot, tender nodule that may or may not have an abscess
Always associated with a hair follicle
Can give systemic antibx and hot compress
If there is an abscess - drain it
Carbuncle is a bunch of furuncles
—deeper infection, interconnecting small abscesses
—Needs systemic antibx and drainage
—Usually needs longer term antibx until all lesions are gone and then needs ppx
—–Choice of antibx is based on culture data
Purpura fulminans: What causes it, what is the presentation and what is the treatment
Cutaneous manifestation of meningcoccemia
Sxs of meningitis are usually present plus hypotension, fever, AMS - all with rapid onset
These purpura spread over the course of hours - very red/purple legs
Patient should be isolated
Treat with ceftriaxone and vanc
How to tell the difference between German Measles and regular Measles?
Rubella - “German Measles”
–Most adults are vaccinated against this
–In general a mild illness
–Begins with petechiae on the soft palate and then erythematous, maculopapular rash on the face which spread to trunk and extremities
—-Rash is more flat than measles
–Also has low grade fevers and malaise
–Treatment is supportive
Measles
–Still part of MMR
–Rash similar to Rubella but is also pruritic, more severe and becomes confluent over the chest
–Accompanied by hacking/barking cough
–Extremely contagious
–Treatment is supportive care but can lead to encephilitis
What is Ramsay-Hunt Syndrome
Varicella Zoster that involves the facial nerve (CN VII)
-Steroids are needed to treat
How to treat genital yeast infections
Usually caused by candida sp.
Keep area dry
Treat with topical miconazole
Pathophysiology of psoriasis
Exact cause is not fully understood
Theorized that it is an alteration of the cell kinetics of keratinocytes
Cell cycle is shortened which results in 28 times the normal production of epidermal cells
Lesions are indolent and present for months/years in the same place
Psoriatic lesions have abundant T cells so treatment focused on slowing them down
Types of skin cancer
Basal Cell carcinoma - most common and most benign
–limited ability to metastasize
–Usually solitary, shiny red nodules
Squamous cell carcinoma
–Most often occurs on the head
–Can metastasize and are much more destructive
–Surrounding skin usually has an inflamed appearance and there is often regional adenopathy from mets
Malignant melanoma
-Asymmetry
-Borders (irregular with edges and corners)
-Color (vareigated)
-Diameter (greater than 6mm)
-Evolving over time
Pathophysiology of erythema multiforme
Langerhan cells in the skin recognize a natural antigen (that of an infection) or a drug and recruit antigen presenting cells
An antigen presenting cell stimulates cytotoxic T cells and T helper cells to initiate autoimmune reactions that attack the Langerhans cells by mistake
Presentation of erythema multiforme
Rash is urticarial, typically erythematous, edematous papules of varying size and shape with central clearing
Erythema multiforme minor: typical rash but does not involve the mucus membranes and typically is mild - resolves in 7-10 days
Erythema multiforme major: (Steven-Johnsons Syndrome) typical minor presentation plus one or more of the mucus membranes with membrane erosion, desquamation of 10% or less of the TBSA
Toxic Epidermal Necrolysis (TEN)
–SJS plus >30% desquamation of the TBSA
Treatment of Erythema Multiforme Minor
Antihistamines and supportive care
Make sure to monitor for blisters
–If there are blisters, need to go to hospital for evaluation of erythema multiforme major
Treatment of Erythema Multiforme Major
Considered a dermatological emergency
Supportive care although treatment is controversial
Corticosteroid treatment controversial
Ophthalmology consult should be placed as corneal scarring can cause blindness
Needs burn unit admission and consults to ophtho, rheum, PT, OT
Treatment of Toxic Epidermal Necrolysis (TEN)
Needs dedicated burn ICU
Nikolsky sign - when you rub your finger over the skin, it sloughs off
Need to replete electrolytes
Clinical presentation of pyoderma gangrenosum
Thought to be due to immune system dysfunction, specifically that of neutrophils
Hallmark is pathery - the appearance of new lesions at sites of mild trauma
Any attempts to help the problem make it worse
Biopsy shows a neutrophilic infiltrate
Treatment is corticosteroids and cyclosporine
Be careful that dressings do not stick to it
What is the clinical presentation of actinic keratoses?
Small patches occurring on sun exposed parts of the body
Pre-malignant - can progress to squamous cell carcinoma
Asymptomatic
